FACTIOUS DISORDER MASQUERADING AS IDIOPATHIC ANAPHYLAXIS

Abstract

Introduction Idiopathic anaphylaxis is a diagnosis of exclusion with a broad differential. We present a patient with multiple ICU admissions in a two-month period treated as anaphylaxis but without supportive objective findings. Case Description A 14-year old female presented with subjective lip angioedema and stridor concerning for anaphylaxis, without a known trigger. Subsequently, she was admitted to an inpatient eating disorder unit given newly discovered significant weight loss. During her hospitalization, 6 codes were called for anaphylaxis resulting in 5 ICU admissions and 1 elective intubation given persistent stridor despite optimal treatment. These episodes consisted of subjective lip swelling with pursing and stridor which coughing resolved. Patient was treated as idiopathic anaphylaxis after reassuring evaluation of other etiologies. She began a long-term prednisone course for frequent idiopathic anaphylaxis which was not effective. When it was noted her episodes occurred with progress in her treatment, she received a diagnosis of factious disorder. With psychiatric treatment, her anaphylactoid episodes resolved. Discussion This case demonstrates the need to consider non-organic causes in the differential diagnoses of idiopathic anaphylaxis. The patient's symptoms were viewed by providers as anaphylaxis and thus were treated without meeting NIAD criteria on several occasions. [1, 2] Ultimately, her symptoms were most consistent with factious disorder. Prior reports have discussed patients with symptoms consistent with anaphylaxis but who do not respond to treatment and whose symptoms are found to be non-organic. [3, 4] These patients can be difficult to manage and respond best to treatments for their underlying psychiatric diseases.